Zeitschrift fur arztliche Fortbildung最新文献

A medical expert opinion concerning lumbar syndrome as an occupational disease should only be made if the condition of adequate job-related stress exists. There are no difficulties to diagnose the chronic lumbar syndrome. However, the assessment of the connection in cause may be difficult because of the lack of strong distinctive criterias between job-related degenerative signs and those due to fate. Guidelines for decision-making are demonstrated. The degree of disability due to occupational disease considers the part of the labour market which is closed to the insured person out of functional aspects and preventive reasons. In order to avoid job-related lumbar syndromes, preventive measures at the working place should be the common aim of all involved disciplines in collaboration with the technical service.

The exclusive involvement of the lungs with A lambda-type amyloidosis in nodular dispositions in a case of Sjögren's syndrome is very rare. An immunoglobulin lambda-type light chain, benign, monoclonal gammopathy has been verified as the ethological cause. The urine concentration of paraproteins was below the detection limit of the common examination methods and could only be found immunoelectrophoretically in urine concentrated 100-200 fold. The question of a possible relationship with Sjögren's syndrome is being discussed.

The intervertebral disk, the small vertebral joint, the musculature, and ligamentous apparatus may become the origin of back pain, and, the clinical examination aims for the exact palpation complemented by the functional probe of posture and free mobility. The physiotherapeutic action is orientated according to the main symptom: For acute lumbago, mobilization supported by analgesic measures as soon as possible after the acute painful stage has eased. The blockade of vertebral joints necessitates manual therapy, warmth and/or electrotherapy need to be added for cramped muscles. Infiltration is applied for ligamentous pain, active posture exercises are needed for muscular weakness. If the therapeutic options are limited in the elderly patient, passive measures like segmental massage for muscle relaxation are legitimate.

The prevalence of back pain is increasing. Usually, back pain is associated with additional vegetative, functional, and mental disorders. Mental factors may contribute to the maintenance of pain and to chronification. The degree of the back pain has a wide variety. According to an international consensus, it is tried to take the view of back pain as a biopsychosocial model. The accordingly derived psychosomatic treatment procedures need a differential indication. Beside the basic psychosomatic treatment, the individual therapy by qualified psycho-therapists and the behaviour therapeutic and depth psychological oriented group therapy by specifically trained physicians belongs to the psychosomatic procedures.

During the past three decades, the use of implants both in urology and other surgical specialties has experienced exponential growth. The development of implantable genitourinary prostheses has similarly grown from simple testicular substitutes to the large group of implantable penile prostheses, artificial urinary sphincters, prostheses in neurology, and possible future developments of artificial bladder and ureteral materials. The majority of urologic prostheses are constructed of silicone, because it is relatively inert, but nevertheless silicone causes some local tissue reactions and deteriorates with time. Currently, much research is underway studying the effects on the human host. Although multiple mechanical malfunctions of these prosthetic devices have occurred, periprosthetic infection is the most disastrous complication which usually leads to removal of the prostheses. This article gives the clinician an overview of common complex urologic implants, especially the current development of prostheses in the field of neurology.

The results of evaluations proceeding the educational seminar "Psychosomatic Primary Care" in South Baden are presented and analyzed. From 1991 to 1995, approximately 450 physicians took part in these courses. From critical feedback and suggestions for improvement obtained from participants following each course, recommendations for future seminars pertaining to content, structure, process, didactic and evaluation are presented.

In only 30% of back pain patients an underlying pathology can be found. Rheumatologic causes in a narrow sense are fibromyalgia, osteoporosis and the group of spondylathropathies and reactive arthritis. Infectious disorders of the spine are emergency cases and need immediate and interdisciplinary action. Careful evaluation of signs and symptoms indicate the suspected origin of pain and lead to the use of more specialized diagnostic means. Therapy of specific back pain should be appropriate to the clinical disorders. In acute, nonspecific back pain, the aim is to prevent a chronification of disease by instruction and education of the patient and an early start of physical therapy. The rehabilitation process in chronic cases in complex and may need psychobehavioral methods for pain control. Pharmacologic modalities of treatment-simple analgesics, nonsteroidal antirheumatic drugs, muscle relaxants and antidepressants-should only be used for a limited period and monitored constantly.